When I spoke again with Mandy Winkler, the Appeal and Grievance officer that had been working on my case, she told me it had been re-assigned to another appeal officer, and I would have to talk with her.
Susie Fraser, the person who took over, told me that, since I had gone through all the appeal levels with this appeal, she would have to open a brand new appeal. The only difference with this one was that it was affected by the last letter that I had received from UHN, stating the TAG guidelines, and I was promised by her lead, Leah, that if I met the guidelines, they would cover it. Leah stated to me also that they were pushing the appeal process through in a 7-day period instead of a 30-day, like they normally would, making the due date of the answer Sept. 16th.
At that point, I was a at a total loss. I was too tired to be angry, since it took too much energy just to wake up and go to work every day. What I was, was confused that the insurance division seemed to think they were doctors when they were not, and they were complicating their guidelines to keep from paying for the surgery by arguing what the guidelines MIGHT mean.
I contacted Walter Lindstrom to help me, since I had not successfully or satisfactoraly solved anything with PacifiCare or UHN. I warned them, hoping this would push some action through. I didn't know how I would pay for it, but was hoping for a windfall of some sort to come through.
I posted on my personal website and here, including Susie Frazer's address at PacifiCare, requesting that if anyone felt that these goings-on were unfair, to write and tell her so.
September 25th, I got the information back from the second chem-scan, and hemoglobin test since, according to PacifiCare, the first one was inconclusive. Lo and behold, I was still diabetic. So, my PCP sent that information back at PacifiCare. September 29th, I was still waiting for the Associate Medical Director of PacifiCare to look at my file. They stated that they now needed all of my medical files from my Dr, since there wasn't enough evidence to decide either one way or another. They also stated that my PCP hadn't sent them anything at all, even though they requested the information three weeks prior. My PCP sent in the information yet again.
October 5th, I looked at the calendar, and realized that I was supposed to be coming home from the hospital that day. I was still waiting for the decision. The Appeal and Grievance agent told me that the Associate Medical Director had until the end of the week to close the case and decide, as it was state law.
I called October 7th, and spoke with Susie, asking that she call me back with a status. She called me back later the same day to let me know that I had finally been approved. I immediately called the surgery scheduler, and he put me down for December 14th.
I called the scheduler on November 23rd, and found out that my surgery date was on a Tuesday, and Dr. McConnell only did the surgery on Wednesdays. They rescheduled me for December 29th and put me on a rotation for an earlier date if possible. More drama was to come, however.
December 5th, my roommate and friend had an appointment with Dr. McConnell and was told to let me know they were going to change my surgery date again, this time to January 5th. The approval date cut-off was set for January 6th. When I called the scheduler, she told me it was due to Y2K updates, so the surgery theatres were all closed except for emergency cases that week. I decided to take matters again into my own hands.
December 6th, I took time off of work and sat in the waiting room of OHSU until they decided to let me have December 13th for a scheduled surgery date. Dr. McConnell was not happy about it, but agreed that after everything I had been through he may have done the same thing in my shoes.
My mother came down the day before the surgery. My roommate and I had just moved to another house, so everything was in disarray just before I went under the knife. Mom helped us get settled in, and stayed by me for as long as she could. The morning of the surgery wasn't bad, other than the fact I kept having to check in at all these different places, and was fast falling asleep. I got there at 6am, and the surgery wasn't scheduled until noon or so. I fell asleep waiting a few times. They set me up on an epidural, and asked me questions about myself to help relax me. Then I was wheeled in to the operating theatre, and set myself onto the operating gurney. I don't remember anything else until I woke up, groggy and thirsty, in ICU, with Dr. McConnall chuckling over me about something I had said. I still don't remember what it was.
So, thus is the saga up to the point of the surgery. From this point on, it's update city. Take care, it's been an incredible journey, teaching me patience and perserverance.
